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<meta name="description" content="口腔影像学的第三个问题：CBCT，换一本中文书看。感谢作者！口腔颌面锥形束CT(Cone Beam Computed Tomography），又称数字容积体层摄影，1998年由意大利研制成功。CBCT能从三维角度，即矢状位，冠状位和轴位来显示病变组织和正常组织结构，避免了二维平片的固有缺陷。CBCT的原理：看知乎上的回答吧，我觉得比书上说得清楚。 CT的成像原理是什么？ - Tian的回答 - 知">
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        <p>口腔影像学的第三个问题：CBCT，换一本中文书看。感谢作者！<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/01.jpg"><br>口腔颌面锥形束CT(Cone Beam Computed Tomography），又称数字容积体层摄影，1998年由意大利研制成功。<br>CBCT能从三维角度，即矢状位，冠状位和轴位来显示病变组织和正常组织结构，避免了二维平片的固有缺陷。<br>CBCT的原理：看知乎上的回答吧，我觉得比书上说得清楚。 <a target="_blank" rel="noopener" href="https://www.zhihu.com/question/24978900/answer/252728892">CT的成像原理是什么？ - Tian的回答 - 知乎 </a><br>伪影产生的常见因素：<br>①运动伪影：产生的原因主要是由于患者在拍照过程中，头颅的移位，下颌骨的不自主运动等造成的，表现为双重影像。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/02.jpg"><br>要求患者在CBCT扫描过程中保持稳定和尽量减少投照时间来避免。<br>②位置伪影：指被投照物体过于靠近扫描视野的边缘，物体边缘的图像容易产生光环样伪影。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/03.jpg"><br>③射线束硬化伪影：它的产生是由放射线本身决定的，即在一束放射线内放射线光子所携带的能量是不一致的，能量高的放射线光子通过高密度物体，如牙釉质、金属充填体等时，产生较强的散射线而呈条索样高密度影像；而低能光子则被吸收，表现为发散状透影带。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/04.jpg"><br>④系统伪影 系统伪影产生的因素主要有两个，一个使由于CBCT的摄影模式，即旋转一周获取容积数据原始图像决定的，其可产生表现为光环征得伪影<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/05.jpg"><br>另一个是由于计算错误所造成的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/06.jpg"><br>( 临床上常见的是修复体造成的伪影，常对邻牙的图像产生干扰。我曾经吃过亏。)<br>在牙及牙周疾病中的应用：<br>①多生牙定位；<br>②阻生牙：可精细显示阻生牙与下颌管壁的关系，包括颊舌向位置，有无骨间隔，以预测术中损伤下牙槽神经的可能性，同时反映下颌第二磨牙是否存在外吸收。与下颌管壁不完整相关的曲面体层片影像学征象中，以下颌管壁骨白线中断和牙周影像改变的统计学意义最明显。CBCT在预测下牙槽神经暴露方面的敏感度与特异度比曲面体层片无显著性优势，但CBCT提供的冠状位图像反映了牙根与下颌管的颊舌向关系，这有利于术中采取适当措施，以减少损伤下牙槽神经的风险。<br>③牙髓及根尖周病：观察根管系统解剖及根尖周骨质情况。CBCT及手术显微镜对于变异根管的发现和定位具有重要意义，可用于对变异根管的初步观察。<br>④牙周炎牙槽骨吸收：主要目的是检测牙槽骨缺损的程度。传统CT和 CBCT检查牙周骨缺损的误差小于根尖片和曲面断层片，且CBCT影像质量最佳。<br>⑤牙根外吸收：根尖片识别牙根外吸收的假阴性率约51.9%，假阳性率约为15.3%，尤其当病损位于颊侧或舌侧根面时，准确率更低。CBCT能够显示病变的真实形态和部位，确定病变范围，并可发现先前未发现的吸收缺陷。<br>⑥牙根纵裂：指牙根部出现贯通髓腔和牙周膜的裂纹。CBCT可三维观察，对于牙根折裂可提供较为精确的信息。根充物的存在降低了CBCT的特异度，但未明显影响其准确率。牙根折裂的CBCT诊断标准：图像上存在低密度线状影，贯穿根髓与牙周膜或贯穿牙根断面；断端可以明显移位，也可没有明显移位。对于移位不明显者，CBCT图像表现为至少连续两个层面上存在低密度折裂影，且该折裂影至少可在两个不同方位平面上显示，同时需排除临近组织伪影的干扰。<br>在颞下颌关节病中的应用：<br>关节间隙的改变：健康成人正中颌位时关节上间隙&gt;关节后间隙&gt;关节前间隙。TMD关节间隙的变化：有多种情况，包括整个关节间隙增宽，表现为髁突下移位；整个关节间隙变窄，表现为髁突上移位；关节前间隙增宽而后间隙变窄，表现为髁突后移位；以及关节前间隙变窄而后间隙增宽，表现为髁突前移位等。其中以关节前间隙增宽而后间隙变窄（即髁突后移位）最为常见。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/07.jpg"><br>关节盘病变：主要包括各种关节盘移位及关节盘附着松弛或撕脱等。关节盘移位中以关节盘前移位最为常见，分为可复性盘性前移位及不可复性盘前移位。<br>骨质改变：髁突骨质硬化，髁突骨质破坏，髁突囊样变，髁突骨质增生，髁突磨平、变短小，髁突松质骨结构变化，关节结节及关节窝硬化、变浅平。<br>在种植中的应用<br>CBCT的应用使牙槽骨骨量的测量和分析变得更加容易，测量结果可以精确到0.01mm。①垂直高度，可以首先在与颌骨长轴垂直的横断面图像上测量，但也应在重组曲面全景片图像上进行补充测量和确定。在上颌骨，这个高度应是从牙槽嵴顶沿着预计的种植体的长轴至鼻底或上颌窦下缘的距离。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/08.jpg"><br>在下颌骨后部（颏孔之后），这个高度是从牙槽嵴顶到下牙槽神经管上壁密质骨边缘的距离。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/09.jpg"><br>在颏孔部应该测量牙槽嵴顶到颏孔最下缘的距离及牙槽嵴顶到颏孔颊侧上缘的距离。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/10.jpg"><br>在双侧颏孔之间的下颌骨前部，应该测量种植体与下颌骨下缘的角度。如果有下牙槽神经前部曲回，那么牙槽嵴顶到这个前部曲回的距离也应该测量。<br>种植体的最大长度应该始终比牙槽骨的垂直长度短1-2mm。<br>②近远中距离：主要体现在重组曲面全景片图像上，轴平面影像可以辅助观察。对于大多数无牙颌牙弓，最重要的数据是下颌骨两侧颏孔间的牙弓长度，以及上颌骨两侧尖牙突起之间的牙弓长度。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/11.jpg"><br>最多种植体数目=距离/（种植体宽度+相邻种植体最小间隙）<br>③唇颊侧至舌腭侧距离，主要在与颌骨长轴垂直的横断面影像上测量。每一个设定的种植体均需测量牙槽骨唇颊侧至舌腭侧的最宽及最窄距离。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/12.jpg"><br>一般一个种植体唇颊侧和舌腭侧都应该有至少1mm厚度的骨组织包围。所以牙槽嵴宽度应该不少于2mm+种植体宽度。<br>牙槽骨质量：分四类，二类和三类被认为是最适合于种植体的类型。<br>CBCT应用于口腔颌面部影像诊断中的优势与缺陷：优势：①三维观察，包括轴位、冠状位及矢状位观察；②图像反映结构的真实大小；③可于立位或坐位进行扫描；④体素各向同性；⑤二维图像观察，包括重组曲面全景平、头颅正侧位片等；⑥空间分辨率高，可用于观察骨小梁结构、根管结构、牙周膜等；⑦辐射剂量较低；⑧金属伪影干扰相对较小；⑨设备相对简易，操作简单。⑩适用于DICOM格式存储、传输，并可供第三方软件后处理。缺陷：①密度分辨率低，提供较少的软组织信息；②照射野受限，不同品牌与型号的机器照射野不同；③散射线造成图像噪音较大，信噪比低；④投射时间长，运动伪影影像较大；⑤照射野边缘伪影；⑥不能应用CT值评价组织密度。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0020-kqyxx-cbct/13.jpg"></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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